Abstract
BackgroundScreening for, diagnosis and management of intrauterine growth restriction (IUGR) is often performed in multidisciplinary collaboration. However, variation in screening methods, diagnosis and management of IUGR may lead to confusion. In the Netherlands two monodisciplinary guidelines on IUGR do not fully align. To facilitate effective collaboration between different professionals in perinatal care, we undertook a Delphi study with uniform recommendations as our primary result, focusing on issues that are not aligned or for which specifications are lacking in the current guidelines.MethodsWe conducted a Delphi study in three rounds. A purposively sampled selection of 56 panellists participated: 27 representing midwife-led care and 29 obstetrician-led care. Consensus was defined as agreement between the professional groups on the same answer and among at least 70% of the panellists within groups.ResultsPer round 51 or 52 (91% - 93%) panellists responded. This has led to consensus on 27 issues, leading to four consensus based recommendations on screening for IUGR in midwife-led care and eight consensus based recommendations on diagnosis and eight on management in obstetrician-led care. The multidisciplinary project group decided on four additional recommendations as no consensus was reached by the panel. No recommendations could be made about induction of labour versus expectant monitoring, nor about the choice for a primary caesarean section.ConclusionsWe reached consensus on recommendations for care for IUGR within a multidisciplinary panel. These will be implemented in a study on the effectiveness and cost-effectiveness of routine third trimester ultrasound for monitoring fetal growth. Research is needed to evaluate the effects of implementation of these recommendations on perinatal outcomes.Trial registrationNTR4367.
Highlights
Screening for, diagnosis and management of intrauterine growth restriction (IUGR) is often performed in multidisciplinary collaboration
No further recommendation was made by the Summary of the main findings In this Delphi study consensus was achieved between professionals working in midwife-led and obstetricianled care on 27 statements, resulting in twenty recommendations for prenatal care for IUGR; this may contribute to optimizing the multidisciplinary teamwork throughout all levels of perinatal care
Percentages do not always add up to 100% due to rounding error IUGR intrauterine growth restriction, SFH serial fundal height, CGC customised growth chart, EFW estimated fetal weight, IUGR Risk Selection (IRIS) IUGR risk selection, Fetal anomaly scan (FAS) fetal anomaly scan, NVOG Dutch Society of Obstetrics and Gynaecology
Summary
Screening for, diagnosis and management of intrauterine growth restriction (IUGR) is often performed in multidisciplinary collaboration. Variation in screening methods, diagnosis and management of IUGR may lead to confusion. Infants with intrauterine growth restriction (IUGR) are at increased risk for perinatal morbidity and mortality [1,2,3,4]. Screening for, diagnosis and management of IUGR are important assignments for all caregivers in perinatal care [5,6,7]. Additional diagnostic testing by ultrasound biometry is done if indicated, based on relevant history, pregnancy complications or clinical suggestion of IUGR based on abdominal palpation or SFH measurements [8, 9]. If IUGR is Verfaille et al BMC Pregnancy and Childbirth (2017) 17:353 suspected, additional tests such as Doppler velocimetry can show redistribution patterns of blood flow, suggestive for the fetal adaptive response to suboptimal conditions, either caused by asphyxia or maternal malnutrition [15,16,17,18,19]
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